运动联合营养干预对老年肌少症体成分和躯体功能及睡眠质量的影响

doi:10.16138/j.1673-6087.2026.01.04

摘要/Abstract

摘要：

目的：探讨有氧联合抗阻训练及营养补充对老年肌少症患者体成分、躯体功能及睡眠质量的影响。方法：纳入2024年1月至6月上海市第四康复医院呼吸康复科门诊及住院的老年肌少症患者83例，随机分为对照组（有氧训练，n=42）和干预组[有氧联合抗阻训练+含维生素D₃与β-羟基β-甲基丁酸盐（beta-hydroxy-beta-methylbutyrate, HMB）的乳清蛋白制剂，n=41]，治疗周期为12周。观察治疗前后骨骼肌指数（skeletal muscle index, SMI）、25羟维生素D水平、握力、6 m步速、简易体能状况量表（short physical performance battery, SPPB）等指标，并采用匹茨堡睡眠质量指数（Pittsburgh sleep quality index, PSQI）、失眠严重程度指数（insomnia severity index, ISI）、艾普沃斯嗜睡量表（Epworth sleepiness scale, ESS）评估睡眠质量。结果：干预组治疗后SMI、25羟维生素D、6 m步速及SPPB总分显著优于对照组（均P<0.05），干预组5次起坐时间治疗前后改善差值显著大于对照组（P<0.05）。睡眠质量方面，2组治疗后主观睡眠质量、睡眠效率、PSQI总评分、ISI评分显著改善（均P<0.05）；干预组主观睡眠质量、睡眠时间、睡眠障碍、PSQI总评分、ISI评分及ESS评分较对照组改善更显著（均P<0.05）。Logistic回归分析表明，干预方式[优势比（odds ratio, OR）=2.698, P=0.020]及合并骨质疏松（OR=2.362, P=0.043）均对患者睡眠质量的改善具有影响。结论：相较于单纯有氧训练，有氧联合抗阻训练并结合营养补充的干预方式能更有效地改善老年肌少症患者的肌肉功能和睡眠质量。干预方式及是否患有骨质疏松是影响患者睡眠质量改善疗效的重要因素。

关键词: 肌少症, 抗阻训练, 有氧训练, 维生素D₃, β-羟基-β-甲基丁酸盐, 乳清蛋白

Abstract:

Objective To investigate the effects of combined aerobic and resistance training along with nutritional supplementation on body composition, physical function, and sleep quality in elderly patients with sarcopenia. Methods A total of 83 elderly outpatients and inpatients with sarcopenia from the Department of Respiratory Rehabilitation at the Fourth Rehabilitation Hospital of Shanghai between January and June 2024 were enrolled, and were randomly assigned to a control group (aerobic training only, n=42) or an intervention group [combined aerobic and resistance training + whey protein supplementation containing vitamin D₃ and beta-hydroxy-beta-methylbutyrate (HMB), n=41] for a 12-week intervention. Measurements including skeletal muscle index (SMI), 25-hydroxyvitamin D level, grip strength, 6-meter gait speed, and short physical performance battery (SPPB) score were examined before and after treatment. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), and Epworth sleepiness scale (ESS). Results After treatment, the intervention group showed significantly greater improvements than the control group in SMI, 25-hydroxyvitamin D level, 6-meter gait speed, and total SPPB score (all P<0.05). The change in 5-time sit-to-stand performance was also significantly greater in the intervention group (P<0.05). Regarding sleep quality, both groups demonstrated significant post-intervention improvements in subjective sleep quality, sleep efficiency, total PSQI score, and ISI score (all P<0.05). Compared with the control group, the intervention group showed more pronounced improvements in subjective sleep quality, sleep duration, sleep disorders, total PSQI score, ISI score, and ESS score (all P<0.05). Logistic regression analysis indicated that the intervention modality [odds ratio (OR)=2.698, P=0.020] and comorbid osteoporosis (OR=2.362, P=0.043) were both associated with the improvement of sleep quality in patients. Conclusions Compared with aerobic training alone, a combined intervention of aerobic and resistance training with nutritional supplementation is more effective in improving muscle function and sleep quality in elderly patients with sarcopenia. The intervention modality and the presence of comorbid osteoporosis are significant factors influencing the efficacy of sleep quality improvement.

Key words: sarcopenia, resistance training, aerobic training, vitamin D₃, beta-hydroxy-beta-methylbutyrate, whey-protein

中图分类号:

R592
R493

张音, 沈宏华, 许轶明, 杜井波, 刘杰, 吴顺军, 凌小楠, 任蕾. 运动联合营养干预对老年肌少症体成分和躯体功能及睡眠质量的影响[J]. 内科理论与实践, 2026, 21(01): 28-38.

ZHANG Yin, SHEN Honghua, XU Yiming, DU Jingbo, LIU Jie, WU Shunjun, LING Xiaonan, REN Lei. Effects of exercise combined with nutrition intervention on body composition, physical function and sleep quality in elderly patients with sarcopenia[J]. Journal of Internal Medicine Concepts & Practice, 2026, 21(01): 28-38.

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项目	对照组（n=42）	干预组（n=41）	t/χ²	P
*：Fisher精确检验。
年龄（岁）	83.62±7.48	80.78±8.40	1.627	0.108
年龄分层（岁）[n (%)]			1.167	0.243
65~75	9 (21.4)	16 (39.0)
76~85	15 (35.7)	9 (22.0)
>85	18 (42.8)	16 (39.0)
性别[n (%)]			1.487	0.223
男性	13 (31.0)	18 (43.9)
女性	29 (69.0)	23 (56.7)
合并症[n (%)]
冠心病	19 (45.2)	18 (43.9)	0.015	0.903
高血压	28 (66.7)	23 (56.7)	0.978	0.323
卒中	13 (30.0)	8 (19.5)	1.437	0.231
慢性气道疾病	6 (14.3)	7 (17.0)	0.122	0.727
2型糖尿病	14 (33.3)	9 (22.0)	1.342	0.247
骨质疏松	21 (50.0)	19 (46.3)	0.111	0.739
身高（m）	1.60±0.09	1.63±0.09	1.406	0.164
体重（kg）	55.08±10.79	54.88±8.25	0.096	0.934
BMI（kg/m²）	21.50±2.95	20.83±3.12	1.008	0.317
BMI分层 [n (%)]			-	0.105^*
<18.5	11 (26.2)	9 (22.0)
18.5~23.9	20 (47.6)	27 (65.9)
24.0~27.9	11 (26.2)	4 (9.7)
≥28.0	0 (0.0)	1 (2.4)

指标	对照组（n=42)	干预组（n=41)	t/F	P
与对照组相比，1）: P<0.05；与治疗前相比，2）:P<0.05；与对照组治疗前后差值相比，3）：P<0.05。
BMI（kg/m²）
治疗前	21.50±2.95	20.83±3.12	1.008	0.317
治疗后	22.17±3.15	21.52±2.88	0.747	0.390
t	0.983	1.073
P	0.328	0.287
治疗前后差值	0.67±0.61	0.69±0.68	0.128	0.898
25羟维生素D(ng/mL)
治疗前	20.45±5.23	21.29±7.04	0.620	0.537
治疗后	21.04±4.81	25.30±6.91^1）2）	15.081	0.0002
t	0.541	2.607
P	0.590	0.011
治疗前后差值	0.59±2.98	4.02±6.13^3）	3.225	0.002
小腿围（cm）
治疗前	29.20±3.79	29.11±2.81	0.131	0.896
治疗后	29.76±3.93	30.60±2.47	3.811	0.055
t	0.659	1.509
P	0.512	0.135
治疗前后差值	0.55±0.86	1.49±1.04^3）	4.490	<0.000 1
VFA（cm²）
治疗前	110.10±48.71	95.47±40.48	1.489	0.141
治疗后	101.90±49.12	93.73±32.97	2.512	0.117
t	0.772	0.214
P	0.442	0.831
治疗前后差值	−8.24±18.31	1.82±29.42	1.866	0.067
SMI（kg/m²）
治疗前	5.60±1.13	5.82±0.88	1.006	0.318
治疗后	5.77±1.14	6.29±0.88^1）2）	6.427	0.013
t	0.692	2.399
P	0.491	0.019
治疗前后差值	0.17±0.20	0.47±0.51^3）	3.451	0.001

指标	对照组（n=42)	干预组（n=41)	t/F	P
与对照组相比，1）: P<0.05；与治疗前相比，2）: P<0.05；与对照组治疗前后差值相比，3）: P<0.05。
握力（kg）
治疗前	16.22±6.86	16.96±7.01	0.487	0.628
治疗后	17.38±7.18	19.47±8.25	0.519	0.474
t	0.762	1.495
P	0.448	0.139
治疗前后差值	1.17±1.47	2.87±2.93^3）	3.335	0.002
6 m步速（m/s）
治疗前	0.56±0.23	0.59±0.25	0.489	0.626
治疗后	0.63±0.30	0.74±0.35^1）2）	12.292	0.001
t	1.122	2.232
P	0.265	0.029
治疗前后差值	0.07±0.10	0.15±0.14^3）	3.130	0.002
5次起坐时间（s）
治疗前	26.99±17.70	23.81±15.08	0.882	0.380
治疗后	23.86±14.17	16.79±7.86^1）2）	4.205	0.043
t	0.895	2.666
P	0.374	0.009
治疗前后差值	−0.75±4.78	−1.73±6.91	0.753	0.454
SPPB总分（分）
治疗前	4.79±2.17	5.39±2.05	1.305	0.196
治疗后	5.38±2.84	7.12±2.25^1）2）	17.213	<0.000 1
t	1.080	3.645
P	0.283	0.001
治疗前后差值	0.60±1.25	1.73±1.12^3）	4.360	<0.000 1

指标	对照组（n=42）	干预组（n=41）	t/Z	P
与对照组相比，1）:P<0.05；与治疗前相比，2）: P<0.05。
主观睡眠质量（分）
治疗前	1.12±0.71	0.95±0.55	1.210	0.230
治疗后	0.74±0.54^1）	0.61±0.49^1）2）	1.125	0.264
t	2.772	2.971
P	0.007	0.004
入睡时间（分）
治疗前	1(1,1)	1(1,1)	0.057	0.955
治疗后	1(1,1)	1(1,1)	0.605	0.545
Z	1.083	0.591
P	0.279	0.554
睡眠时间（分）
治疗前	0.74±0.59	0.66±0.66	0.583	0.562
治疗后	0.57±0.50	0.22±0.42^1）2）	3.467	0.001
t	1.400	3.611
P	0.165	0.001
睡眠效率（分）
治疗前	1.64±0.79	1.42±0.81	1.303	0.196
治疗后	1.04±0.73^1）	0.90±0.62^1）	0.972	0.334
t	3.582	3.217
P	0.001	0.002
睡眠障碍（分）
治疗前	1(1,2)	1(1,1)	0.353	0.724
治疗后	1(1,1)	1(1,1)^1）2）	2.627	0.009
Z	0.836	2.695
P	0.403	0.007
催眠药物使用（分）
治疗前	0(0,1)	0(0,1)	0.461	0.645
治疗后	0(0,1)	0(0,0)^1）2）	2.046	0.041
Z	0.336	2.978
P	0.737	0.003
日间功能障碍（分）
治疗前	1.38±0.94	1.10±1.00	1.337	0.185
治疗后	1.26±0.66	0.78±0.42	3.124	0.081
t	0.672	1.880
P	0.504	0.066
PSQI总分（分）
治疗前	7.62±3.91	6.93±3.47	0.852	0.397
治疗后	6.05±2.61^1）	4.51±1.86^1）2）	3.090	0.003
t	2.167	3.870
P	0.034	0.000
ISI评分（分）
治疗前	8.31±4.69	7.15±4.68	1.131	0.262
治疗后	6.45±3.33^1）	4.93±3.35^1）2）	2.081	0.041
t	2.092	2.470
P	0.040	0.016
ESS评分（分）
治疗前	8.38±4.40	7.15±3.37	1.434	0.155
治疗后	6.76±3.23	5.20±2.68^1）2）	2.404	0.019
t	1.924	2.609
P	0.059	0.005

疗效	对照组(n=42)	干预组(n=41)	Z	P
无效	21(50.0)	11(26.8)	2.198	0.028
有效	15(35.7)	19(46.4)
显效	6(14.3)	11(26.8)
痊愈	0(0.0)	0(0.0)